It's a problem that's been shouted in newspaper headlines over and over again 34,000 new nurses must be found to meet the needs of Florida's burgeoning elderly population within four years.

But that snowballing statistic comes amidst the nation's worst nursing shortage in a dozen years.

And faced with stiff penalties for too-low staffing counts imposed by Florida's recent nursing home reform legislation, one West Palm Beach nursing home is getting creative about filling its vacant slots.

The Institute for Geriatric Research and Training at the Morse Geriatric Center recently secured a $100,000 grant from the Quantum Foundation for an experimental program it's calling "Linking People With Careers."

The goal: to solve South Florida's severe shortage of certified nursing assistants by recruiting and training "at-risk" populations suffering from high unemployment rates. The institute identifies at-risk populations as people in areas characterized by high crime and unemployment, poor health care and a general "culture of despair."

Many people in those areas face significant barriers to finding and keeping jobs, including child care issues, unreliable transportation, illiteracy, incomplete educational backgrounds and a lack of local role models.

Officials from the state's nursing home associations say they're monitoring the program's success, hoping it may help alleviate the industry's frantic search for qualified nursing staff.

"Everyone is talking about this crisis in health care but there are very few programs on the horizon," said Dr. Alan Sadowsky, executive director of the institute. "We realized that while facilities are crying out for health care workers, there are many areas in the community that are equally in need of stable and secure employment. It's not rocket science, it's an obvious gap in the system."

If it works, it's a solution that can't come quickly enough for the hundreds of Florida nursing homes scrambling to find enough nurses to meet the state's new staffing requirements, said Ed Towey, spokesman for the Florida Health Care Association (FHCA) in Tallahassee.

The nursing home reforms passed in May demand that each of the state's 70,000 nursing home residents receive at least 2. 3 hours of care a day from certified nursing assistants. By 2004, that number must increase to 2. 9 hours a day.

In Palm Beach County alone, Sadowsky estimated that more than 1,200 CNAs must be added within two years to meet the requirements.

The penalty for failing to meet them is stiff: facilities can't admit new patients.

Ultimately, some nursing homes may be forced to take beds off line if they can't increase their nursing staffs, Towey said. If that happens, he said, the homes won't be the only ones to suffer.

"Then it becomes an access to care issue," he said. "And we'll see hospitals start to back up because they won't be able to discharge patients to nursing homes for rehabilitation or convalescence."

But CNA positions characterized by back-breaking work, low respect and even lower pay are among the most difficult for nursing homes to fill, Towey said. A CNA's responsibilities may include transporting residents to and from activities, bathing them, checking their vital signs, providing snacks and helping them use the toilet.

"A lot of new CNAs are gone within 30 days," Towey said. "It's very rewarding work, but it's mentally and physically challenging and not everyone is cut out for it."

Linking People With Careers got off the ground last month with the addition of a program coordinator. Pam Williams, who was picked from a pool of 55 candidates, boasts a resume that includes a mix of health care consulting work and hospital management experience. She also runs First Step Plus, a non-profit organization she created that matches mentors with at-risk children in the area.

Over the next two years, Williams aims to recruit 35 people into the career program. Candidates must live within a series of ZIP codes identified as housing Palm Beach County's most at-risk populations. They may be referred by community, religious or governmental sources or apply directly.

Williams has started speaking at schools and community groups to raise awareness of the program. She also is working closely with the Academy for Practical Nursing and Health Occupations, which allowed her to establish an office at its West Palm Beach facility so she can forge relationships with its students.

In exchange, the Morse Geriatric Center has agreed to offer space in its facility for academy classes, Sadowsky said.

"The more people are exposed to the culture of the Morse, the more likely they are to want to work here," he said. "It's like we're a baseball team and this is our farm system."

The first two candidates were accepted into the career program last month, Sadowsky said.

All candidates must finish nursing school before they enter the program and pass the center's regular screening process, he said.

It's understood that at-risk populations are likely to have problems crop up in their background reports, Williams said. Each issue will be assessed and discussed with the participant, and a zero-tolerance policy will be maintained toward such serious breaches as gang involvement, parole violations and drug abuse, she said.

"People keep telling us that it's a wonderful idea but a daunting task because we're dealing with a very difficult and demanding population," Sadowsky said. "These are people who have no experience being somewhere on a daily basis they've never even owned an alarm clock. It's also an extremely fragile population you may be dealing with a young, unwed mother in a domestic abuse situation."

Once candidates are accepted into the Morse's career program, Williams begins an intensive, on-the-job training and orientation process to help them adjust to the demands of the working world.

That includes regular classes designed to help them develop personal leadership styles, set goals, accept constructive criticism, learn anger management, take pride in their accomplishments and improve their decision-making and communication skills, Williams said. It also includes frequent, impromptu sessions that help her monitor participants' progress and problems that could interfere with their job performance.

In a population that often finds it difficult to establish trust, Williams said one of her biggest challenges is making participants feel comfortable coming to her with problems before they reach crisis levels.

"There's no road map for how to do this. My attitude is that I will do what it takes to get them through the transition," she said. "If that means being here at 2 a. m. to work through someone's first shift or giving them my home phone number so they can reach me at any time, that's what I will do."

The Quantum grant also included contingency dollars for participants who need extra assistance, such as cab fare or a few weeks of child care because a regular caretaker fell ill.

"The first few months are critical for determining if a candidate will be a success," Sadowsky said. "A lot of times employers aren't willing to go the extra mile to give these people a chance. But with the shortage and the way the population is growing, we need to be innovative about meeting our staffing needs."

About 75 percent of the career program's participants are expected to evolve into successful Morse employees, Sadowsky said.

But the center isn't the only local facility that's likely to benefit from the extra supervision and training, he said. In addition to the programs she will offer at the nursing home, Williams plans to lecture students at the nursing academy on such topics as interviewing techniques and dressing for success.

She also will help place candidates for whom there is no position at Morse at other facilities in the area. Those people will still be invited to participate in her follow-up classes and programs, she said.

Excited by such potential, Palm Beach County's Workforce Development Board recently gave the institute a $25,000 grant for the career program.

"While demand in other occupations comes and goes, [nursing] is going to offer stable employment for the next couple of decades," Sadowsky said. "It's a great way to help these people get up and out of the cycle of despair."

Some health care experts are concerned that such benefits could be outweighed by potential problems caused by mixing unstable workers with the frail elderly.

"It's going to be very important to create a structure of accountability with a lot of support for the population that's being trained," said Sarah Tobocman, a shareholder at the Miami office of Gunster Yoakley & Stewart. "They're in charge of people's lives, even if it's only a support role."

But Tobocman, who leads the law firm's immigrations practice group, said she realizes that the nursing shortage has reached "a critical stage." She also has struggled to help health care clients find innovative ways to combat the issue, including recruiting nurses from other countries.

"Anything that could help increase the supply and quality of CNAs and nurses is a good thing," FHCA's Towey said. "If job candidates aren't beating down a path to our door, we need to beat a path to theirs."

He expects the Morse center's experiment to benefit the nursing homes and counties struggling to support those at risk.

"People say, `Oh wonderful, now we're putting these bad people in nursing homes,' but it's not like that at all," he said. "These people still have to pass the same background checks as all other nursing home employees."

Sadowsky said he expects the career program to also improve employee retention rates, a tough task in an industry that suffers from turnover of up to 120 percent in nursing jobs.

"It's not good for the residents when the staff keeps changing as soon as they learn their habits and needs," Sadowsky said. "We feel that by investing in people up front, we're going to reap huge benefits for everyone."